Healthcare Provider Details

I. General information

NPI: 1144491663
Provider Name (Legal Business Name): HON MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 RIDGECREST CIR
CLAYTON GA
30525-4111
US

IV. Provider business mailing address

2172 HUNTERS GREEN DR
LAWRENCEVILLE GA
30043-5185
US

V. Phone/Fax

Practice location:
  • Phone: 770-883-8139
  • Fax:
Mailing address:
  • Phone: 770-995-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number040102
License Number StateGA

VIII. Authorized Official

Name: DAVID C HON
Title or Position: CEO
Credential: MD
Phone: 770-995-4995